Drug ads on TV

lipitor-ad-small.jpg

All I can say is thank God I morphed out of my regular medical practice and into nutritional medicine before the legalization of drug advertising on television. I watch very little TV – mainly NFL games, and usually only those I have a bet on – but even with the minimal amount I do watch I’m exposed to a ton of pharmaceutical ads.

These ads play on the relationship between patients and their doctors to make the drug company cash registers go ching ching ching.

Here is the way the system works. A person watching TV sees an ad for, say, a ‘new’ sleep medication promising a restful night’s sleep. This usually doesn’t prompt a call to the physician for a prescription, but during the next visit to the doc this person says, Hey Dr. So and So, I saw an ad for that new sleep medicine Lunesta. I’ve been having a little trouble sleeping, so could I give that a try? Most physicians will go ahead and write a prescription for that drug. Problem is, the drugs advertised on TV are typically much more expensive than the older drugs that may have gone off patent already and can be had as generics. And the new drugs aren’t any more efficacious than the old drugs. It doesn’t cost the doctor any money to write these prescriptions, so he/she will usually do it. The patient gets a medicine that costs him/her (or the insurance company) a lot more money for a drug that works no better than a cheaper one. So who wins in all this? The drug company, of course.

Any medication you see advertised on television has a less expensive counterpart out there. And typically the less expensive counterpart has had many more years of patient experience without problems or it would have been pulled from the market, so it can be considered even safer as well.

Consumer Reports has started what they say will be a series of attacks on these drug ads. Their first venture is a jab at a drug ad we’ve all seen for the heartbreak of restless leg syndrome. (I’m not always a big fan of Consumer Reports. They do okay when their evaluating toasters to see which is best because there are specific tests the toasters can be put to in an effort to rank them. Where CR gets into trouble is when they start rating various diets using yardsticks that have no scientific merit.)

Link to the video. Sadly, they’ll probably never do one of these debunkings of a statin drug ad.

Warning. The woman who is the CR spokesperson in this video has one of the most annoying voices in the history of video. It has a teenspeak quality to it that just about drove me from the computer. I could barely get the thing watched. But that’s just me. It may not bother others.

While we’re on the subject of television drug advertising, have you been wondering why you’re seeing that Gollum-y Dr. Robert Jarvik touting Lipitor every time you turn on TV, pick up a paper or magazine or even look at the news online? Because the pharmaceutical giant Pfizer is in a blind panic. The New York Times tells why.

Lipitor and other cholesterol-lowering drugs, sometimes called statins, are the largest drug class, with spending of $22 billion last year in the United States alone. And they have been researched more thoroughly than any other group of drugs, making head-to-head comparisons easier.

Many doctors have come to see simvastatin as a viable substitute for Lipitor. Studies show that at commonly prescribed doses Lipitor and simvastatin are equally effective at reducing LDL cholesterol, the so-called bad cholesterol.

A big difference is that Lipitor costs $2.50 to $3 a day, while simvastatin sells for 75 cents to $1 a day at most retail pharmacies, and as little as 10 cents a day at discount pharmacies like Costco’s.

Each month, doctors with patients on Lipitor are switching tens of thousands of them to simvastatin. And simvastatin is also taking a growing share of the market for new patients who need a cholesterol drug. “Simvastatin is much less expensive to society over all and to patients,” said Dr. Thomas H. Lee Jr., a prominent cardiologist. “If you put patients on generics,” he said, “the chances that they’re taking their medications six months later are higher than on a brand name drug. I think that a few hundred dollars a year does matter.”

Simvistatin (Zocor) went off patent last year, you see, so it is now available as the generic. Pfizer, which makes Lipitor, is worried that many physicians will switch their patients from Lipitor to simvistatin, a move that could cost Pfizer hundreds of millions of dollars. (And save patients and insurance companies and therefor all of us the same hundreds of millions of dollars per year.) So, they are blasting the airwaves and print wherever and whenever they can to try to maintain loyalty. I guess we’ll see if it works.

I have a better and even less expensive solution: quit writing prescriptions for statins altogether. There is no real proof that they work for anyone except males under the age of 65 who have already had heart problems. And even then, they work minimally. So if you don’t fall into that category why spend even 75 cents per day for a drug that will do you no good and possibly great harm? Discuss it with your physician.

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40 thoughts on “Drug ads on TV

  1. I don’t even know where to go to check for these numbers, but it would be interesting to know what percentage of drugs that were approved by the FDA were later “pulled,” and what the average time between approval and being pulled is.

    Hi Bob–

    I don’t know where to go to get these figures either. But I remember reading an article in a medical journal about 15 years ago about how there had been no decrease in the number of drugs that had to be pulled from the market even after all the stringent FDA testing was put in place. In other words, the drug making it through all the FDA hoops now has the same probability of being taken off the market as one did that made it through in the pre-thalidomide days. The difference is that all the FDA scrutiny simply makes today’s drugs much, much more expensive while it doesn’t protect us against drugs that turn out to be problematic any better than it did 60 years ago.

    Cheers–

    MRE

  2. I don’t watch much TV either mainly football or some sort of Discovery channel if I’m eating alone, but those drug commercials have driven me nuts. Especially the Jarvik one, the one with the “doctor” teaching the “med students” and the one with the woman chef. I think they’re all cholesterol drugs. I quit taking mine a year ago and have been trying to get my parents to quit taking theirs. Makes me thankful every day that I have DVR and had a brain transplant as you would say.

    Its seems that since they could advertise, they’ve started inventing conditions that need drugs.

    BTW- where did the password thing go?

    Hi Joe–

    I found a new plugin that has the password already encoded in it somehow. It let’s legitimate comments through, but eliminates spam. I don’t have a clue how it works, but it does seem to be working. I finally made my way through all the zillions of spam that had accumulated before I went to the Captcha system, and since starting that and the new system, there have been only a handful.

    Cheers–

    MRE

  3. Dr. Eades,

    This is somewhat tangential, but can you tell me if drug companies track the prescription writing of doctors? The glee with which my doc whips out his prescription pad makes me wonder. Could be he’s happy that he thinks he can offer a solution to my particular complaint, but I can’t help but wonder if he’s not motivated by something other than my well being. BTW, Lipitor is one of those he prescribed.

    Thanks.

    Hi Rick–

    I don’t know the answer to your question. I know they can track the prescription writing in an area by monitoring drug sales there, but I don’t know if they can track it by doctor. Even if they could, I don’t think they could do anything to motivate the doctor, as in give him/her gifts, trips etc.

    Cheers–

    MRE

  4. wtf, you guys never heard of tivo?

    Not only have I heard of it, we have one. It’s just that we never think to use it. If I have a bet on a football game and already know the score because the game took place hours or days before, it isn’t the same experience as watching it live.

    MRE

  5. Well, I hold no brief for big pharma and I hate those drug ads too. But I think the doctors are very much at fault here. The patient may not know that there are cheaper drugs that are just as good, but the doctor is supposed to!

    Hi Emma Ann–

    I know how this works from the doctors side because I used to be a doctor. When patients come in with something specific in mind, it’s hard to dissuade them. They will say that whatever you want to prescribe doesn’t work for them. That’s why they want the new drug. They can be very insistent, and it’s often easier to give in than to fight about it. Especially since the doctor figures, what the heck, it’s no skin off my nose. It’s a brilliant strategy by the pharmaceutical industry.

    MRE

  6. This may not completely answer Bob’s question, but it does provide some interesting recall info:
    http://www.healthatoz.com/healthatoz/Atoz/drugdb/drugGuideRecallList.jsp
    You can click on specific recalls to get the FDA’s report on why the drug/food/item was recalled and, usually, when it first received FDA approval. Yes, it would be a lot of data mining to come up with statistics overall, but this can help you search ones of particular interest. Statins nearly crippled my mother. I’d like to see them banned everywhere.

    I attended a lecture by Zorba Paster (NPR) last week where he told the audience numerous times, “Statins are WONDERFUL DRUGS!” “They’re SO helpful,” he said for lowering “that awful cholesterol.” Of course, he also said that Dr. Atkins “died of a stroke,” so what does he know?? 🙂 Sad thing is, a LOT of people hang on his every word. Sigh…

    I suppose I hate to admit such a thing, but I don’t have a clue who Zorba Paster is. Doesn’t sound like I’m missing much by not knowing.

    Cheers–

    MRE

  7. oh yeah, we’re talkin sports. Nevermind.

    I’ll do anything except watch commercials tho. Sometimes I just hit pause for the minute or two between innings (more of a baseball fan than football), or find some documentary or movie or sumpin to jump to during the breaks.. anything except watching commercials…

    I agree. I hate to watch commercials. I especially hate it during NFL games when team A scores a touchdown and the station cuts to a half dozen commercials. Then it’s back for the kickoff. Then a half dozen more commercials. What I have started doing is Tivoing the game then starting to watch it 45 minutes or so into it. I try to time it so that I can FF through all the commercials and end up hitting the game live just as it ends. I still get the suspense of not knowing the outcome of my bet while avoiding the commercials.

    Cheers–

    MRE

  8. If you REALLY want to hear a lot of drug ads, watch TV during the evening news! I laughed once when the news had an ‘expose’ segment ‘coming up’ about over-prescribing pharmaceuticals, then three of the next 4 advertisements was for a drug! I also see more of the multiple-page ads in news magazines than in other types of magazines, it seems.

    I wonder if having their ads in proximity to news sources, whether broadcast or in print, is an attempt to squeeze their sales pitch in when we’re in a ‘news-watching’ mindset.

    I’m certain they’ll leave no psychological stone unturned in their quest for greater sales of their products.

    Cheers–

    MRE

  9. Hi Dr. Mike –

    I have to give you massive credit for using the term “Gollum-y”. You’ve certainly coined a very descriptive phrase there. I won’t ever be able to look at a Lipitor ad again without thinking “Gollum-y”. Hilarious! It gave me a true chuckle – thanks.

    I just couldn’t quite figure out who he reminded me of, then it hit me.

    Cheers–

    MRE

  10. I was always wondering why we have the explosion of prescription drug ads that I don’t remember seeing even in th eighties or nineties. When did the law change?

    Also, there seems to be combo drugs now hypertension and cholestrol etc. Is this a way of extending patents? As for me, low cost generics are OK … I am a cheap stake I guess.

    As for Lipitor, I have tried to talk to my doctor after I read Protien Power and failed although my cholestrol is normal now. I guess I need to try again and again. I am taking CoEnzyme Q10 though after I read your book.

    Thanks doc.

    The law changed sometime over the last 10 years, but I don’t know when precisely.

    Remember, your doctor only gives advice. It’s up to you whether or not to take that advice.

    Cheers–

    MRE

  11. “This is somewhat tangential, but can you tell me if drug companies track the prescription writing of doctors?”

    I don’t know whether this happens in your country. But in the part of Canada I live in every MD has a physician’s number (or at least used to a few years ago when I was good friends with an MD). This number appears on every prescription written. If the physician’s association has access to prescription records this number would allow them to track the total number of prescriptions written by a member and the type of medication. This would be done of course just to ensure MDs are following established practices and not straying into alternative treatment territory. This is social health care in action.

    On a similar theme, a few months ago the premier of our province (equates with governor) proposed that the health care plan should pay new MDs a $125.00 incentive for every diabetic under their care who adheres to the established treatment protocol (i.e. high carb diet etc.). Put another way, a bounty was being proposed on diabetics. Nice!

    Yes, very nice indeed. A bounty on diabetics. Good way to put it because the recommended treatment will surely bag them.

    Cheers–

    MRE

  12. Hi Mike,

    If you are not a big TV watcher you might have missed the Simpsons take on this;

    http://youtube.com/watch?v=hu14pDU-lD8

    I think satire gets the message across rather well and … ‘interesting’ pill delivery method!!

    The episode goes on to explore the funny side of the Stinox phenomenon (not sure if you call it that) – but there were many stories of users doing very strange things where sleepwalking had not previously been a problem … including driving! (not so funny when you think you might be coming the other way … )

    Cheers,

    Malcolm

    Thanks for the great clip.

    As to the ‘Stinox’ phenomenon, I had my own misadventure with Ambien, which you can read all about in this post of MD’s.

    Cheers–

    MRE

  13. I was totally shocked when I saw the first drug ad on tv. I am still shocked to this day that our government allows this bullshit. 🙁

    Not only are these ads on TV, the pharmaceutical companies that produce them go way over the top. When they start running a new ad for a drug they typically exceed the limits of what is allowable. After they have run these ads for some time, the FDA sends them a warning letter telling them what they need to do to keep the ad in compliance with the FDA rules. Then the companies have (I think) 60 days to conform. In the period of time between starting the ads and the time when they finally start abiding by the FDA regs, they can push a whole lot of drugs.

    Cheers–

    MRE

  14. Zorba bills himself as a “family doctor” and has a huge following on National Public Radio. He pushes the low-fat, high-carb, take-your-statins diet and exercise plan.

    You’re not missing much by NOT knowing who he is…just more drivel.

    No wonder he has a huge following at NPR. People who listen to NPR are by and large not boat rockers.

    Cheers–

    MRE

  15. The drug ads that get me are the ones that go through the whole commercial without telling you what the drug is for, but in the end they say “ask your doctor if xxx is right for you.” I want to throw something through my TV, but since it’s a nice flat panel I refrain.

    The ones that say “ask your doctor if xxx is right for you” are the second generation ads, the ones after they’ve gotten their letters from the FDA. But before they get the letter they tell you exactly what the drug is for, so when you see the second generation ads you’ll know.

    Cheers–

    MRE

  16. My father is taking Lipitor, and when he started, I talked untill I was blue in the face that he needed to take CoQ10 because it was depleted by the statin–that CoQ10 was essential to heart health. All I got was a blank stare. Well, it turns out that he has been getting pins and needles sensations down the length of both his legs, so the doctor told him to go buy CoQ10! He did and it got rid of the symptom, so now he thinks that CoQ10 is a cure for leg pain!

    I’m going to leave it alone.

    God help us all. I’m glad he’s at least on the CoQ10 regardless of what he thinks it is doing for him. I shudder to think of all those on statins (unnecessarily for the most part) who aren’t taking CoQ10, and whose physicians don’t even know what it is. Yet they don’t have a problem prescribing a drug that depletes it.

    Cheers–

    MRE

  17. I’m so glad you addressed the Jarvik ad. That one has me cringing every time it’s on. It’s such a shame that a lot of elderly folks will fall for this, coming from “the maker of the Jarvik artificial heart” and all.

    But Gollum-y? I think he’s kind of cute; sort of elf-like. But then again, I out-and-out swoon whenever I even THINK of Gomez Addams (ok, John Astin) or Gene Wilder (mostly when he played Dr. Frahnkensteen). No accounting for taste, huh?

    Well, Gollum is sort of elf-like right? So I can see the attraction.

    Cheers–

    MRE

    P.S. I’ve got an email in to Dr. McCleary about your ketogenic cocktail question. As soon as I hear back, I’ll post the answer.

  18. If Jarvik looks like Gollum, I guess he looks at his residual checks from the drug company and moans “ooh, my preciousss …”

    I mainly only watch football myself, but between the ads for crap drugs, crap food, crap beer and crap cosmetics (no, dude, if you spray AXE on yourself you will NOT attract a supermodel unless you also have a billion-dollar bank account) TiVo’s looking pretty good.

    Yeah, Tivo can be a Godsend if you know how to use it properly. And I’m sure Gollum’s checks from Pfizer make the gold ring look paltry by comparison.

    Cheers–

    MRE

  19. Have you seen this site? http://www.panexa.com/

    Don’t just glance at it, but really read it. Best. parody. ever.

    Thanks. I particularly like the name of the company: Merd. And the side effect of it’s causing an “inability to distinguish the colors ‘taupe’ and ‘putty.'”

    Cheers–

    MRE

  20. Arrgh! Jarvik’s face staring out at me when I brought up your blog was more than I could take… I see it way too often on my tv screen.

    Sorry.

  21. You might enjoy this film clip of Bill Maher’s comedy special from the Pharma Gossip website dated today, 11/13. It’s a hilarious send up of some drug commercials. http://pharmagossip.blogspot.com/

    It makes me wonder when pharma companies will begin to realize that their game is starting to wear thin and that they are becoming an object of justifiable ridicule. It’ll happen none to soon from my point of view.

    Regards,

    Wil

    Hi Wil–

    Hilarious clip. And I didn’t know this blog existed. I’ll have to add it to my list of reads.

    Cheers–

    MRE

  22. Oh, and here’s another one from the PharmaGiles website. A hilarious send up of the drug ads for restless leg syndrome, which he reconfigures in this pricelessly funny and mildly off color piece as “restless dick syndrome.”

    http://pharmagiles.blogspot.com/search?q=restless+dick

    If you haven’t discovered PharmaGiles yet, I think you will also be greatly amused by his regular send ups of the skewed business model and ridiculous marketing practices of Pfizer, which he thinly fictionalizes a “Phoni Pharmaceuticals.”

    Enjoy,

    Wil

    Yes, hilarious. No, I wasn’t aware of PharmGiles. I’ll add it to my list.

    Thanks.

    MRE

  23. I’m not a sports fan, so I can watch all of my TV on the internet. The networks will put shows up online a day after they first air, or you can, um, obtain them online through other means.

    Whenever I’m at a friend’s house I’m disgusted at the crap ads on tv. No wonder no one has any money to buy the truly important things in life! I wish the pharmaceutical industry would stick to antibiotics and treating the so called “orphan diseases” rather than concentrate on exaggerated or even made up health problems! But there’s no money in that, is there?

    Nope, not much money at all.

  24. Oh, my favorite subject! I could go on and on about this one but I will refrain – suffice it to say that as a recently-retired office administrator for a 2-doctor practice – I CRINGED every time I heard one of those “Call your Doctor’s office and see if XXX is right for YOU!” ads – yep, the ones where they didn’t give even a HINT of what the drug was for.

    It’s no small wonder I STILL hate to answer the phone at home! 😉

    I’ll bet you did cringe. I cringe just thinking about what it must be like in a primary care practice today.

    Cheers–

    MRE

  25. Another ad that CR needs to check is the one for Zetia. It says it lowers your cholesterol 30 points or 18%. If you do the math 30 points is 18% of 167 ( 167 x .18 = 30.06).
    My question is: If your total cholesterol is already at 167 why the hell are you taking a cholesterol lowering drug to bring it down to 137?
    It’s obvious that the marketing firm that made up this commercial just threw numbers in the air.
    Another ad that gets me is the one that says if you eat Cheerios for six weeks you can lower your cholesterol by 4%. If your cholesterol was 200 this would be 8 points. Cholesterol tests aren’t accurate enough to even measure this. But imagine what the carb intake would do to you!

    Truly unbelievable the lengths these bozos will go to to deceive the public.

  26. Not sure which one bothers me most….Jarvik and Lipitor or the food and family Vitorin commercials. (Although at least with Vitorin, the majority of the foods they show are high carb.)

    Glad to see you address this issue. I wish we could get the public to start complaining loudly!! I’ve read that Jarvik hasn’t done much since his initial publicity, and being on his artificial heart is sheer hell! The stars that put their faces on meds bothers me too. I hope they at least believe what they preach! (yea, right!)

    There are a few amusing commercials too….there’s one for a car with a little girl telling her dad a story that’s a riot! No idea which car tho! lol

    They all bother me – Jarvik, Vitorin, that stupid one for a statin that was narrated in Dr. Seussian cadence for Crestor, and all the rest. It’s a testament to how often they run that I, who almost never watch TV, can quote them.

    Cheers–

    MRE

  27. “No wonder he has a huge following at NPR. People who listen to NPR are by and large not boat rockers.” -MRE

    Hey! Gary Taubes was on NPR last week, and they gave him plenty of time to talk about his book, and even brought on a researcher who backed him up!

    (Of course you’re right though, that interview was very much an anomaly for NPR)

    I didn’t realize Taubes was on NPR. I would have listened. I wonder who the researcher was? I’ll bet it was Ron Krauss.

    Cheers–

    MRE

  28. Excellent advice Dr Mike! Being a long time Fibromyalgia sufferer I have at one time or other had many useless medications offered to me. From research and being in touch with other on the internet have come to realize that most of these drugs are not helping. People are taking huge amounts of psychotropic and narcotic medications and have no better quality of life then before. I have never been a huge medication taker and being a nurse in long term care has made me even more concerned about this type of thing.
    I do the MDS (minimum data set) and one question is how many different medications has the resident taken in the last seven days? This question drives a portion of our Quality Indicators from CMS if they take over 9 meds. I pretty much have about 5% of elderly patients that take less than nine medications. Many of our patients are taking cholesterol lowering drugs and to top that off many of them are being paid for by Medicaid. This has got to be a huge drain on Medicaid resources. I know that they are priced cheaper for Medicaid but still when you consider that the research has shown they are pretty much useless for that population this waste of money is a travesty.

    Not only useless, but probably harmful. So we’re spending our tax dollars to buy medicines that are worsening risk. Only in America.

  29. I see these ads when watching US TV shows. They aren’t permitted to advertise these drugs on originating Canadian networks – or didn’t used to be, I don’t know if it’s changed. The one with Jarvick in particular annoys me “everyone over 50 should be on lipitor”? WTH!? I saw a new one on the weekend for Celebrex – happy cartoon doves and convertible cars with a soft monotonous female voice going on and on about NSAIDs. I’ve long suspected there is some formula to these; lilting voice, pretty pictures, “small print” warnings and list of possible side effects coming later in the commercial once you’ve tuned out.

    All designed with the help of big dollar advertising whizzes to get you to simply ask your doctor to let you give it a try. Since they all list the side effects, that just becomes background noise.

  30. And oh yeah, I have to join in and add my view to the other comments about Dr. Jarvik in his Lipitor ads: he comes across as a sleazy little weasel from whom I would not purchase a used car. He has no credibility whatsoever at this point, assuming he ever had such in the first place.

    Wil

  31. Jarvik as Gollum – Oh, my preciouss—-I just about choked on my coffee, I laughed so hard.

    I hate all drug ads, on tv or in magazines. It takes 2 pages just to list the side effects! The worst tv ad, though, was for Wellbrutin. It listed all the possible side effects, including stroke and seizures (!), but the selling point? No sexual side effects. You might be drooling from stroke or seizure, but by gum, you can have sex! (Yes, it probably helps a lot of people, but still, should that be the major selling point?) And let’s not even venture into the drugs for e.d. Again, they probably help a lot of people, but the ads are just absolutely horrendous. (What’s with couples sitting out in the wide open spaces soaking in clawfoot tubs, anyway? Does Cialis make you need a bath?)

    Thanks for another informative post, Doc.

    Glad you enjoyed it.

  32. If Lipitor makes you look like Jarvik, I’ll pass. 🙂 When he says “Lipitor isn’t for everybody,” I correct it with “Lipitor isn’t for ANYBODY.”

    If the drugs are soooo good, why the need for heavy advertizing? The whole thing makes me skeptical. I was starting to wonder if they were just making this “restless leg syndrome” stuff up to sell drugs. According the CR video, it is a real, but rare condition, but the ads can have a psychsomatic effect in people.

    Sometimes those ads make me angry, like when my 10-year-old asked, “What’s E.D.?” They talk about high blood pressure and diabetes causing E. D. There is a better solution, control your blood pressure and diabetes with low carb. I was diagnosed with both conditions and I don’t need no stinkin’ Viagra or Levitra.

    Yeah, it’s hard to believe. When I was a kid and I Love Lucy was the big TV show, Lucy and Ricky had to be shown sleeping in separate beds. Now kids are exposed to the term erectile dysfunction multiple times per day. One wonders how many 5- and 6-year olds have asked their parents what that means?

    Best–

    MRE

  33. Drug companies target their demographic. The baby boomers watch the evening news. It drives my mom nuts to see all the Cialis commercials. I tell her not to watch the evening news. 😉

    I never see drug ads shown on, say, Cartoon Network.

    You’re not telling me that the baby boomers are starting to need Cialis, are you? Please don’t.

    BTW, they advertise all the junk food on the Cartoon Network so that the kids can grow up fat and diabetic so they will then need the drugs when they’re old enough to watch them on the evening news.

    Cheers–

    MRE

  34. Dr. Eades,

    I can’t seem to find any entries about Lucidal. Is it on your to-do list?

    Hi Dave–

    I’m a partner in the company that makes and sells Lucidal. I try to keep my own commercial interests off this blog, so I probably won’t be posting about it.

    Best–

    MRE

  35. The Jarvik ads always trigger an involuntary mute-button-punching reflex. There is something very creepy-scary about a doctor shilling for a drug company like that. But then drug companies are creepy-scary.

    I’d like to recommend some good reading to you and your readers on the subject of the drug companies. Three very different books, each one well worth reading:

    The Truth About the Drug Companies by Marcia Angell. Angell was a long-time editor of NEJM and knows whereof she speaks. This book is strong stuff. In particular the chapter in which she tackles the drug companies’ perpetual refrain “we have to charge Americans so much in order to pay for all the ree-search”.

    Overdosed America by John Abramson.

    Selling Sickness by Ray Moynihan and Alan Cassels

    I can also recommend an excellent series of articles, “Suddenly Sick”, that ran in the Seattle Times a couple of years ago: http://seattletimes.nwsource.com/news/health/suddenlysick/

    Hi Karen–

    I agree. Creepy-scary.

    I haven’t read Selling Sickness but I did finally read Overdosed America a couple of weeks ago. It was absolutely fascinating. I’ve been meaning to post on it. It’s a terrific book.

    Cheers–

    MRE

  36. If not NPR, what radio do you think the boat-rockers listen to?

    I don’t know because I don’t listen to radio. But I can tell you that it probably ain’t NPR.

    Cheers–

    MRE

  37. “Malcolm

    Thanks for the great clip.

    As to the ‘Stinox’ phenomenon, I had my own misadventure with Ambien, which you can read all about in this post of MD’s.”

    Ah, so you did! Sorry, I had forgotten about that – probably a bit close to home then. (BTW Stilnox (sorry about the typo) and Ambien are the same thing (Zolipidem) and from the flood of news stories here, you don’t need to be mixing up an Ambien and alcohol cocktail for either the potential embarassing or plainly dangerous side effects to ensue – eg;

    http://www.theage.com.au/news/National/Lawyers-trawling-bizarre-Stilnox-reports/2007/04/02/1175366136953.html

    You can just imagine how long a natural supplement would last on the market with even a fraction of these reported adverse outcomes, but drug companies seem to be judged by a different standard (or not judged at all).

    As you know, I am a strong advocate for free speech but I must admit that I would find it hard to get worked up about the ban on prescription medication advertising we have in this country (ads such as the ones reported here are banned on TV, press and billboards etc just like tobacco is). Mind you we still have food companies who have no problem advising the great unwashed to choose their products because they reduce “cholesterol re-absorption” …

    Cheers,

    Malcolm

    Hey Malcolm–

    I, too, am an advocate for free speech, but advertising drugs seems a little beyond the pale. I would think that it should only be okay to advertise these drugs accompanied by full disclosure of all risks and side effects.

    Cheers–

    MRE

  38. We use our DVR a lot to avoid to watching commercials (especially drug commercials). But we only delay the show by approx 10 minutes per half hour of programming. That way, by the time we have watched the show and whizzed through the commercials, we just about catch up with real time at the end of the show.

    That’s what we try to do whenever we actually watch a TV program other than football.

    Cheers–

    MRE

  39. Mike, I started out as a writer — first in newspapers, then moved into media (specifically copywriter/creative director.) So I watch commercials. I admire a commercial that can actually say what it needs to say and make a memorization impact in 30 seconds, even when only aired a few times. I’ve actually been known to watch *collections* of commercials. I know–sick. And yeah, I listen to the radio, too. 😉

    But Mike, some of the angst I’m reading here is just a little skewed. Not all generics ARE created equal. Not all new drugs have a counterpart–yet. And pretty much no ad, good or bad, was created by the company who made the drug.

    ‘Any medication you see advertised on television has a less expensive counterpart out there’ is not always quite the case. There may be a similar drug out there…and there may NOT be, yet. NDAs (new drug applications) are for a drug which somehow, some way, differs in mechanism of action or effect or is tolerable to different conditions or effective in lower or less frequent doses. There has to actually be a difference for it to qualify as an NDA, and get approved. Sometimes, that difference is the thing that makes taking that med possible for a percentage of the population. And if you really need the med, that difference can be the world.

    Drug companies don’t make the ads–they buy them (or rather, the ideas for them.)
    Advertising companies make the ads, and drug companies approve them–but things like Jarvik, or prostate–a growing problem or Cialis ads–they are all a creative department idea (or failing). It ain’t the science selling that stuff. It’s the people the company pays to think up a way to market it, who sell it to the suits in the front offices of the drug company’s marketing group.

    Sure, there are ad and marketing types in every drug company–but they serve mainly as translators to the creatives in the outside world who speak their own language and have their own sets of three-letter-acronyms. Internal media outsources the heavy lifting of creating the campaigns to the bona fide ad agencies. I used to be one of the ad agency people who had to come up with the marketing plan packages and the slogans and then sell it to the suits from whatever company we were pitching. Bibles, durable medical equipment, insurance, industrial washing machines, charitable giving programs–describe your product and it was my job to sell it (whether I thought it was stupid or not–which is one reason I am no longer in advertising!) If the resulting ad is stupid or insulting, it’s because the drug company bought it, but not because they dreamed it up.

    One very good series of pharma ads, IMO, is the one promoting pharmaceutical research and Glaxo Smith Kline. It shows researchers, and why they choose their area of research, but none of them promote a specific drug. It reminds me why I enjoyed creating the kind of advertising that makes you think (yes–there is such a thing!). And it makes me proud to have spent 14 years doing preclin R&D drug safety research, and to now be making that work possible for others. It rings true in the context of the scientists I work with, and it feels real. Hats off to the company that created that idea, and to GSK for not messing with the good idea.

    The first rule of being a smart creative is to never show a client a bad idea–because even if it’s presented in the context of five or six other amazing ideas, the client will embrace the bad idea every time. EVERY time. So shame on whatever ad company thought up the idea of talking mucus to promote the decongestant Mucinex…but I can’t really blame the drug company for buying it. It’s exactly the kind of cute crap suits from stiff companies love. It was my job as a creative to make sure that kind of bad choice wasn’t even presented to them so they wouldn’t make fools of themselves. And clearly, someone in the ad agency dropped the ball the day talking mucus sounded plausible!

    I really like the story of Mucinex, an over the counter expectorant/decongestant, which used to be available as the generic prescription guaifenisen and has always been available in liquid form as plain old unglamorous Robitussin expectorant cough syrup and its generic counterparts. The plain expectorant type of Mucinex, which I take daily because I live in the rain-soaked northeast (instead of somewhere like Tuscon), contains 600mg of guaifenisen–just like the old scrip stuff. The company that marketed the prescription version (which cost me about $6 for 60 tabs, versus the 50 cents per tab Mucinex costs), somehow failed to renew the right paperwork and lost the right to sell it about five years ago. Enter Mucinex, at approximately 8 times the price of the prescription drug. After about 12 months on the market, I began to see an unbranded tablet form of the drug that is relabeled and sold on the internet and in Walmart–but it’s a lower dose per tab…and the price for two tabs is just about the price for the branded med…so no payoff in going generic there. The generic is not equal to the branded product–you have to take more of it to get the same effect. And yes, in that case, the company is clearly protecting an investment in name and marketing $$$ with direct to the consumer drug costs.

    But, to take this in another direction–I belong to an employer-sponsored health insurance plan. In those programs, patients frequently HAVE to purchase the generic version of a prescription. The insurance company makes that decision–not the doc, and not the patient. The insurance company can deny coverage of any price in excess of the generic’s cost, and they do. Been there, paid the bills to prove it. I’m sure you remember that little box at the bottom of a scrip pad…and the phrase ‘dispense as written if box is checked’ or something similar. The doc must specifically X that box in order for the patient to get the branded version when an exact equivalent generic is available. Otherwise, the dispensing pharmacy gives out the generic–per the insurance company branch of the healthcare industry. It would be the insurance companies and health care plans and pharmacies scoring on that one, Mike–not the docs, and not the ad agencies, and most days, not the patients, either.

    One of my pharmacy benefits is that I am eligible for any med my company manufactures free of charge–if it can be dispensed by a pharmacy and self-administered. There aren’t a lot of meds my company makes that you’d WANT to be sick enough to have to take, and infusion meds don’t count. But our employee prescription benefit, regardless of the health insurance plan chosen, mandates use of a specific mail order pharmacy…and any scrip for what the plan classifies a maintenance med MUST be written for 90 days, with three 90 day renewals, and filled by mail for a preset minimum copay (which can go up if the med costs more.) If the employee chooses to use the local bricks/mortar pharmacy, all fills after the 3rd one are charged 100% to the employee at the current retail price for the drug. And the prescription benefit for drugs that can’t be filled mail order or for those first three fills while a doc is trying to figure out what med/dose works for you, is a minimum $10 copayment, or 10% of the retail cost, whichever is *greater.* If the doc does a dispense-as-written 90-day scrip and you try to fill it mail order, it will be bounced back to the doc to rewrite if a generic is available. So I can’t just go in and ask to try Ambien unless I’m willing to pay the retail cost of the drug at my local pharmacy. Trust me, THAT gets old fast.

    Anti-emetic pre-meds for chemo infusions were $60 for six pills (two infusions), and the low molecular weight injectable heparin I take daily is $100/month for 30 doses (charges for needles and syringes are extra, of course.) Neither med was eligible for mail order, so I had to pay 10% of retail (since it was greater than $10.) I pay for the sharps I need for the heparin out of pocket…it’s 30 cents a setup from my local pharmacist (who thinks it’s possible I have the worst prescription benefit he’s ever seen), versus 28 cents a setup if I were to get them on a maintenance scrip from the mail order pharmacy. The group scoring on this arrangement is not the employees…it’s the mail order pharmacy and the underwriter guaranteeing the policy for the company. I don’t think the company is scoring that well, either…but they wanted to set an example as part of the pharmaceutical industry. My *mother* gets her meds cheaper than I do…and I subsidize her medicare part D plan with my taxes. When she and I are taking the same med (thankfully, that doesn’t happen often, but it did briefly with a couple meds during chemo), I was effectively paying twice…once through the nose for my meds, and once via taxes for hers.

    And no, I cannot justify the prices charged at retail for new drugs…even though I do know the average time to approval (it used to be 15 years; I think certain drugs, when fast-tracked, can be brought in under 8 years) and I do know the costs associated with developing a new meds. I am one of those costs, after all (IT support, and before that, the staff that actually compounded the drugs and did the preclin testing). But that is a feedback loop that is bigger than an ad campaign that prompts a viewer to ask a doc about X medication.

    I think Saturday Night Live could do a lot with that material…or any of the commercial spoof sites. But I’m not sure the drug companies are the only ones responsible for the ads. I’ve learned first hand that what insurance will approve and what they mandate about scrips plays a huge part in what a doc will write, and what a pharmacy will fill.

    As always…to paraphrase Arsenio Hall, something to make me go ‘hmmm’.

    Hi Gaelen–

    Your points are well taken. I should have written that most medications you see advertised on television have less expensive counterparts out there. It is true that there are some new categories of drugs, but most of the ads I’ve been afflicted with are for drugs for which there are several counterparts that are at least as effective.

    I agree that Mucinex is a great drug for loosening congestion in the chest and sinuses. I used to prescribe it all the time when it was prescription. Too bad it is so expensive now.

    And, I agree that the ad agencies should take out the wretched ideas before they present all the choices to the client. They should never present anything they themselves don’t like, because Murphy’s Law militates that that will be the one chosen.

    I never thought about the impact that the mail order pharmacies have since I’ve never used one. After your explanation, however, I can see how they would contribute greatly to the explosion of health care costs. Reading all this, I’m kind of glad I’m not in an active practice right now.

    Best–

    MRE

  40. Dr. Mike and Literate Cohort:
    I arrived at this site looking for commentary on the rash of pharmaceutical ads that use acronyms (e.g. BPH aka enlarged prostate, isn’t it the other way around?) and the term
    ‘guys’ instead of ‘men’, as if this colloquial tone ratifies the acceptability of taking the med.
    Who started this nonsense ? and who else is irritated by the linguistic aspect ON TOP of the criminal marketing of expensive and often counter productive drugs?

    Hey Charles–

    I’m agitated about both the sorry linguistics and the criminal marketing.

    Cheers–

    MRE